This is a 48 year old man who presented with a history of 20 foot fall from a roof that resulted in a left temporal bone fracture, mixed hearing loss in the left ear, and persistent dizziness and headaches. His dizziness was worsened with straining and lifting.

Repeat high resolution temporal bone CT scans revealed a large tegmen defect associated with an old temporal bone fracture and a dehiscence of the left superior semicircular canal. MRI scans revealed herniation of brain into the mastoid.

A. Left - sided meningoencephalocele and large tegmen defect. Extradural dissection of the left middle fossa skull base following craniotomy reveals a large tegmental defect. In this image, the meningoencephalocele was reduced and a split calverial bone graft, harvested from the bone flap from the middle fossa craniotomy, was used to resurface the tegmen defect.

B. Left SCD. Exploration of the left middle fossa skull base also revealed a small SCD. The membraneous labyrinth is clearly evident as a gray membrane surrounded by a bony defect.

C. Plugging of left SCD. Bone wax was used to gently plug the SCD. The patient had a 2 day hospital stay and 2 months later has resolution of dizziness and improvement of headaches.